We take the National Health Service for granted now, but it is only 50 years ago that health care was a luxury not everyone could afford. It is difficult today for us to imagine what life must have been like without free health care and the difference that the arrival of the NHS made to people’s lives.

Just before the creation of the NHS, the services available were, as you might expect, the same as after; no new hospitals were built nor hundreds of new doctors employed. What was different was that poor people often went without medical treatment, relying instead on dubious - and sometimes dangerous - home remedies or on the charity of doctors who gave their services free to their poorest patients.

Access to a doctor was free to workers, who were on lower pay, but this didn’t necessarily cover their wives or children, nor did it cover other workers or those with a better standard of living. Hospitals charged for services, though sometimes poorer people would be reimbursed. Even so, it meant paying for the service in the first place - which not everyone could afford.

The need for free health care was widely recognised, but it was impossible to achieve without the support or resources of the state.

Throughout the 19th century, philanthropists and social reformers working alone had tried to provide free medical care for the poor. One such man was William Marsden, a young surgeon, who in 1828 opened a dispensary for advice and medicines. His grandly named London General Institution for the Gratuitous Cure of Malignant Diseases - a simple four-storey house in one of the poorest parts of the city - was conceived as a hospital to which the only passport should be poverty and disease and where treatment was provided free of charge to any destitute or sick person who asked for it.

The demand for Marsden's free services was overwhelming. By 1844 his dispensary, now called the Royal Free Hospital, was treating 30,000 patients a year. With consultant medical staff giving their services free of charge and money from legacies, donations, subscriptions and fund-raising events, the Royal Free - now re-housed in larger premises - struggled to fulfil Marsden's vision until 1920 when, on the brink of bankruptcy, it was forced to ask patients to pay whatever they could towards their treatment - just like every other voluntary hospital in the country.

As well as the charitable and voluntary hospitals, which tended to deal mainly with serious illnesses, the local authorities of large towns provided municipal hospitals - maternity hospitals, hospitals for infectious diseases like smallpox and tuberculosis, as well as hospitals for the elderly, mentally ill and mentally handicapped.

Mentally ill and mentally handicapped people were locked away in large forbidding institutions, not always for their own benefit but to save other people from embarrassment. Conditions were often so bad that many patients became worse, not better.

Older people who were no longer able to look after themselves also fared badly. Many ended their lives in the workhouse - a Victorian institution feared by everyone - where paupers did unpaid work in return for food and shelter. Workhouses changed their names to Public Assistance Institutions in 1929, but their character, and the stigma attached to them, remained.

Extracts from this text first appeared as a special foreword by Alan Langlands in Britain 1998: An Official Handbook, produced by the Office for National Statistics and published by The Stationery Office (ISBN 0-11-620942-0). Price £32 hardback.